Double mini-locking plates for unstable Danis-Weber B distal fibular fractures: superior functional outcomes and lower implant removal rates.

BACKGROUND

Unstable Danis-Weber B distal fibular fractures require anatomical reduction. However, conventional lateral locking plates (LLP) are frequently associated with soft-tissue irritation, high implant removal rates, and limitations in rotational stability. This study aimed to evaluate whether a low-profile double mini-locking plates (DMLP) provides superior clinical outcomes compared to LLP.

METHODS

This was a retrospective cohort study of 120 patients with unstable Danis-Weber B fractures treated between 2016 and 2020. Patients were divided into DMLP and LLP groups according to the fixation method employed. Associated posterior and medial malleolar fractures were treated as needed. Outcome measures included time to radiographic union, AOFAS ankle-hindfoot scores, complications, and implant removal rates over 36 months.

RESULTS

The DMLP group achieved significantly faster radiographic union than the LLP group (12.35 vs. 13.48 weeks, p = 0.032). Functionally, patients treated with DMLP demonstrated significantly higher AOFAS ankle-hindfoot scores from 3 months post-operatively through the final follow-up (p < 0.05). Although the DMLP technique required a longer operative time (p < 0.001), the overall complication rate was significantly lower (5.0% vs. 15.0%, p = 0.049). Notably, implant removal was performed significantly less frequently in the DMLP group (41.7%) than in the LLP group (65.0%) (p = 0.009).

CONCLUSIONS

DMLP showed accelerated union and superior functional recovery compared to LLP. Although the operative time was longer, the technique appeared to be associated with fewer soft-tissue complications and a lower rate of secondary implant removal. DMLP may serve as a viable alternative for unstable fractures, though prospective studies are needed to confirm these findings.